Charlatans

by Robin Cook

  “Was he informed of the seriousness of what he was facing?”

  Dr. Mason tipped forward again and eyed Noah. Instinctively, Noah leaned back as much as his chair would allow.

  “I told him I was going to operate on him,” Dr. Mason said slowly, emphasizing each word. “What went on in his pea brain, I have no idea. But listen, my friend. We are wasting time here. Tell me! Did you talk to Dr. Ava London, the uppity bitch?”

  “Yes, I have,” Noah admitted, trying to maintain a neutral expression. Knowing what he did, he was appalled at Dr. Mason for calling Ava an uppity bitch.

  “Well, she is the one mostly responsible for this catastrophe,” Dr. Mason snapped. “And to tell you the truth, I don’t know if she should be on the staff here at BMH. I don’t know if she is qualified.”

  “She is board-qualified in anesthesia,” Noah offered.

  “Yeah, well, I don’t know how good anesthesia boards are to let someone like her pass. I’ve never been all that impressed with Dr. London, nor have some of the other staff. I’ve tried to be nice to her, but there is some disconnect in her personality. Frankly, she is a cold fish.”

  I’m sure you have tried to be nice to her, Noah thought sarcastically but didn’t say.

  “I want you to make it crystal clear at the M&M that general anesthesia should have been used on this patient at the get-go. If it had been, we could have gone into the abdomen when we needed to do so. Admittedly, the patient might have regurgitated anyway during induction since his stomach was so full, but who’s to know. At least it would have happened at the beginning of the case and not at the middle, and it would have been an anesthesia fatality, not a surgical one. It’s aggravating to have this screw up my statistics.”

  “So you think Anesthesia is solely responsible?” Noah said, trying to keep disbelief out of his voice.

  “The lion’s share,” Dr. Mason said. “Of course the patient didn’t help, and Admitting should have discovered the man had eaten a full breakfast. Making sure the patient has been NPO is a major responsibility for them, everybody knows that.”

  “Thank you for your time,” Noah said. He got to his feet.

  “Let me warn you once again, my friend. Do not turn this case into a discussion about concurrent surgery. That is not the issue here. The fact that I was held up for a few minutes in one of my major cases because of a congenital abnormality was not a factor in Bruce Vincent’s death. You get my point?”

  “I believe I do,” Noah said.

  “Good,” Dr. Mason said. “It is nice to have you as our super chief resident. It would be a tragedy if your year was prematurely terminated.”

  A cruel smile appeared on Dr. Mason’s face. He didn’t stand up.

  Noah nodded a final time, then turned and left. As he punched the elevator button out in the hall he became aware that his heart was racing. Although he knew he shouldn’t have been surprised, he had not expected Dr. Mason to be quite so specific with his threat. Noah’s worst-case scenario would be losing his position at BMH this close to the end of what had been a long odyssey and practically a lifelong dream.

  Once again, he was the only person in the elevator. With trembling hands he took out his mobile phone and texted Ava: Met with the enemy. Bad as expected. Will fill u in 2nite. Almost immediately the three little blinking bubbles appeared on his screen. As the elevator door began to open, a message popped up: At least you got it over with. I can’t wait to hear what he said. The message was followed by a smiley-face emoji.

  Feeling relatively chipper from Ava’s text, despite the meeting with Dr. Mason, Noah emerged from the elevator onto the second floor of the Young Building, which served as the triage center for the BMH clinical services. His intent was to use the pedestrian bridge to get back to the Stanhope Pavilion. His destination was the fourth floor, to see if he could locate the chief anesthesia resident. For several days he’d entertained the idea of possibly interviewing Dr. Kumar, but after Ava had told Noah that he and Dr. Mason were close friends, Noah decided against it. Although both Dr. Wiley and Dr. Chung had corroborated Ava’s interpretation of the Vincent case, Noah wanted confirmation from someone higher up just to be sure.

  11

  SATURDAY, JULY 8, 7:39 P.M.

  Knowing he was early, Noah slowed down as he entered Louisburg Square. He noticed the ambient light was significantly greater than it had been the evening before with the sun higher in the sky. Sunset wasn’t going to occur for another half-hour. There were more children playing in the grass enclosure, and their shouts and laughter echoed in the confined area. Bright sunlight bathed the façades of the town houses on the upside of the hill, whereas those on the lower side, where number 16 was located, were in comparatively dark shadow.

  A few doors away from his destination, Noah stopped and looked at his watch and wondered what to do. He was going to be twenty minutes early, and he didn’t want to seem too eager. Of course, he was too eager. He admitted it. As the day had passed, he’d gotten progressively more excited about returning to Ava’s that evening. And the excitement wasn’t just because of the M&M issue, although it contributed. He was looking forward to spending more time with Ava just to be with her, a feeling he couldn’t remember experiencing since he’d been a teenager. But as she’d already made clear her reluctance to form social relationships with fellow hospital personnel, he knew he had to proceed slowly, lest he scare her away. Arriving early could send the wrong message.

  As he was standing there dithering, he saw Ava’s door open. With a sense of panic, he tried to decide what to do and whether he should turn around and flee. Before he could make a move, Ava stepped out onto her stoop, saw him, and waved.

  Noah hesitantly waved back and restarted walking toward her. A moment later a second figure appeared from inside her house. It was a light-complected, clean-cut man, maybe forty, but what caught Noah’s attention was that he was even more athletic-appearing than Ava, which was saying something. He was wearing loose-fitting black workout pants with a white V-neck T-shirt that appeared to be a size too small. Even from where Noah was, he could see that the man’s biceps were straining the fabric. Noah felt instantly inadequate as he mentally compared his own body image to this physical Adonis. It was like day and night. When Noah got to the base of the stoop, the man came down the steps. There was a distinctive spring to his gait. With a slight, friendly smile he nodded to Noah as he passed. Noah nodded back and mounted the granite stairs.

  “See you tomorrow, same time,” Ava called after the man.

  The man didn’t answer or even turn around. He merely waved over his shoulder as he climbed into a black Suburban parked in front of Ava’s house.

  “You’re early,” Ava said cheerfully as Noah gained the top step.

  “Sorry,” Noah said. “Fearing I was going to be late, I rushed. I guess I didn’t need to, but it was a little after seven by the time I was able to leave the hospital.” He had indeed rushed to get home, practically jogging the entire way. He’s also taken a very quick shower, fearing for the worst about being late, but then here he was being early. He’d been keyed up all day and still was.

  “You made good time,” Ava said. “Come in! Sorry about my being in my workout clothes yet again. We went over the allotted time we had set, and I didn’t expect you for at least another twenty minutes or so.”

  “Who is ‘we’?” Noah asked as he entered the foyer. The inner door was also ajar.

  “That was my personal trainer,” Ava said. She followed Noah inside.

  “So you believe in personal trainers,” Noah said. He felt a sense of relief that the man with the buff body was a hired hand.

  “I do. Don’t you?”

  “Not really. Anybody can say they are a personal trainer. I think there are a lot of charlatans out there.” Noah silently chided himself for being jealous.

  Ava laughed her sparkling laugh. “So you
think you can tell?”

  “I can’t,” Noah said. “That’s the problem. There is a legitimate certification, but not all of them have it. I think you have to be careful to get what you pay for.”

  “My trainer is certified. I’m sure of it. He’s very good and very motivating.”

  They ended up standing at the base of Ava’s main staircase. As he had done on his previous visit, Noah made a point of keeping his eyes on hers and not allowing his line of vision to stray elsewhere. He liked the yoga pants but didn’t want it to be obvious. The two cats reappeared, sniffed Noah disdainfully, then disappeared.

  “So we’re back to where we were last night,” Ava said flirtatiously. “I need to take a shower and change. You can make yourself at home in whatever room you’d like, or we can do what we did last night.”

  “Meaning?” Noah asked.

  “We talked about doing take-out again tonight. I know you were the one to go and get it last night, so it is unfair to ask you to do it again, but . . .”

  “I’d be happy to do it,” Noah offered eagerly.

  “That would be terrific. Why don’t we try Toscano tonight?”

  “I didn’t know they did take-out.” Noah was aware of the Italian eatery on Charles Street as a Beacon Hill favorite and had eaten there with Leslie on several occasions.

  “They most certainly do,” Ava said. “I’ve used them many times. Give them a call! Order whatever you want and get the same for me. I’m not choosy. I have some great Italian white wine in the fridge. It will be a treat. How do you feel about your on-call team tonight? As good as last night?”

  “They’re fine,” Noah said. He had checked, trying to plan ahead. The in-house chief resident on call was Cynthia Nugent, who Noah thought was just as competent as Tom Bachman, if not more so. Once again he felt confident he wouldn’t be called unless the sky fell in.

  “Then you might be willing to have a glass or two of wine.”

  “I will enjoy it,” Noah said. It was an amazing feeling to be with someone who truly understood his responsibilities without his having to explain them.

  —

  SLIGHTLY LESS THAN an hour later, Ava and Noah were back at the counter table in the kitchen. Night had fallen and a floodlight illuminated Ava’s tiny garden, which included a fountain. Since the sliding glass doors were open, the sound of the water could be heard over the classical music that was quietly playing in the background from hidden speakers. Noah had ordered quite a feast, and Ava had opened a chilled bottle of Falanghina Greco.

  “Will it ruin your enjoyment of your dinner if we start talking about serious stuff?” Ava asked with a playful smile. She was dressed in a mostly white butterfly-print summer dress, which Noah thought was charming. In contrast, he was wearing almost the same thing he had the night before. He had agonized for a time after his shower about wearing something different, but his choices were limited. He had briefly thought about wearing his resident whites just because he felt the most comfortable in them and thought he looked his best, but had nixed the idea as totally ridiculous. He’d mocked himself for being so pitifully insecure.

  “As you like,” Noah said. He, too, was interested in getting it out of the way.

  “You said in your text that your meeting with Dr. Mason was as bad as expected. Care to elaborate?”

  Putting down his wineglass, Noah took a deep breath. “Just as we feared, we’re definitely in his crosshairs. He threatened to have me fired if I turn the case into a discussion of the concurrent-surgery issue.”

  “Good God,” Ava said with emotion. “He literally threatened to have you terminated?”

  “Well, not in so many words. What he said was that it would be a tragedy if my super chief resident year was prematurely terminated, which I take as the same thing.”

  “The bastard,” Ava snapped. “I’m sorry. What about me? Did he talk about me specifically or about Anesthesia in general?”

  “I’m afraid it was about you specifically,” Noah said. “You were so right last night when you described him as having a narcissistic personality problem. The man is a classic case. As you suspect, it’s pretty obvious that he was and is insulted by your rebuffing him. The man is out of control.”

  “So what did he say, exactly? You don’t have to mince words. I can take it. I just want to know what I am up against.”

  “Again, he said you were mostly responsible for what happened,” Noah said, lowering his voice as if someone might overhear. “It is so obvious that he is incapable of accepting any blame whatsoever. And by his putting the blame on you, it has him questioning if you should be on the BMH staff.”

  “Why? Because of my personality or my qualifications?”

  “I’m afraid a little of both,” Noah said reluctantly. The last thing he wanted to do was hurt Ava’s feelings, yet he felt obligated to speak the truth. “Dr. Mason said you were a cold person, which made me bite my tongue, knowing what I know.”

  “Thank you,” Ava said sincerely.

  “You’re welcome,” Noah said. “With respect to your qualifications, I reminded him you had passed your anesthesia boards, at which point he questioned the anesthesia boards. I’m telling you, the man is out of control.”

  For a few moments Ava stared out at the fountain in her garden. It was obvious to Noah that she was upset and turning the news over in her mind. Noah felt bad for her, but he felt worse for himself. He still didn’t think it likely that Dr. Mason could get her fired even if Dr. Mason was good friends with Ava’s boss. Whereas with himself, Noah was concerned Dr. Mason could possibly get him dismissed or, at a minimum, make his position tenuous if he put his mind to it. After all, he was an associate director of the surgical residency program and therefore was one of just three people in charge.

  Ava redirected her attention back to Noah. “Let me guess,” she said. “Dr. Mason thinks I should have given general anesthesia even though it had been communicated that he wanted spinal.”

  Noah nodded. “He claims not to have asked for spinal, and that his secretary merely included it because it had been used on the last hernia he’d done a hundred years ago. He said it is Anesthesia’s job to determine the appropriate anesthesia, and he didn’t care which was used.”

  Ava took a deep breath. “You do have your work cut out for you.”

  “Don’t I know,” Noah agreed. “I keep thinking it is going to be like walking in a minefield.”

  “Did he bring up the patient and his role in this tragedy?”

  “He certainly did. Actually, considering everyone involved in this case, Dr. Mason might be the angriest at the patient. He described him as having a ‘pea brain’ despite the man’s beloved employee reputation around the hospital. Deep down, Dr. Mason certainly knows it was the patient’s fault by eating a full breakfast and lying about it. But Dr. Mason also faults Admissions for not being more aggressive and finding it out.”

  “All right,” Ava said, suddenly motivated. “Let’s talk specifics.” She sipped her wine and then took a bite of her dinner. “I’ve given this situation a lot of thought since yesterday evening,” she said. “First off, I think you have to understand it will be counterproductive to get into any kind of argument with this man, because if he gets mad, we can both lose. You are going to have to present the case with that restriction in mind.”

  “Easier said than done,” Noah responded. “He got mad this morning, and I was trying to be as diplomatic as I could.”

  “So what did he get mad at? Let’s analyze it.”

  At that moment Ava’s mobile phone chimed, indicating she was getting a call. She picked up the phone, noticed who was calling. Immediately she pushed back from the counter. “Sorry,” she said to Noah. “I’ve got to take this.”

  “Quite all right,” Noah said. He watched her leave the room, vaguely wondering who could be calling after nine on a Saturday night
. For him it would have been easy to guess: the hospital. But he knew Ava was not on call. Noah toyed with his food, thinking it was impolite to eat without her. In the distance, he could just barely hear her voice, although at one point it became decidedly louder, as if she were angry.

  After about five minutes Ava returned, placed her phone facedown on the counter, and climbed back onto her seat. “Sorry about that,” she said. “I know taking calls makes me a less-than-perfect hostess. But what can you do? Silly business sometimes interferes.”

  “Is everything all right?” Noah questioned.

  “It’s fine,” Ava said, with a wave of her hand. She smiled reassuringly. “Now, where were we?”

  “You were asking what Dr. Mason got mad at when I spoke to him this morning.”

  “Right. So tell me!”

  “I’d have to say he got the maddest when he was talking about the lack of a resident history and physical because the resident was backed up. Dr. Mason is one of those old-school surgeons who is convinced we residents today have it easy while he and his contemporaries worked themselves to the bone.”

  Ava nodded. “I know the type. But it is interesting that he would zero in on that issue. I think that is important to remember. What else did he get mad at, specifically?”

  “When I questioned him if he had personally examined the patient.”

  Ava laughed. “Knowing what we do about his temperament, are you surprised such a question made him angry?”

  “I suppose not,” Noah admitted, smiling in the face of Ava’s laughter. In retrospect, he lambasted himself for not being more circumspect. He should have worded the question to Dr. Mason differently so it wouldn’t have been interpreted as being critical. When dealing with a narcissist it is crucial to avoid any suggestion of blaming. “I was trying to be diplomatic but failing.”

  “I’d say!” Ava responded. “Tell me this: Did he bring up again any nonsense of you being responsible for the death since you put the patient on bypass?”